The Transform Nutrition Research Consortium convened the research symposium ‘Evidence for action in South Asia’ on Saturday 8 July 2017, at the Yak and Yeti Hotel, Kathmandu, Nepal. Over a hundred participants from NGOs (national and international) and academia working on nutrition, health and public health, rural and social development gathered together with government officials from Nepal, India and Bangladesh, donor agency representatives and journalists to discuss the important issue of tackling undernutrition in South Asia
The Transform Nutrition Research Consortium convened the research symposium ‘Evidence for action in East Africa’ on Thursday 8 June 2017, at the Southern Sun hotel, Nairobi, Kenya. A hundred participants from NGOs and academia working on nutrition, health, child welfare and development gathered together with government ministers from Kenya and Ethiopia, donor agency representatives and journalists to discuss the important issue of tackling undernutrition in East Africa.
Patrizia Fracassi, Senior Nutrition Analyst and Strategy Advisor for the Scaling-Up Nutrition Movement Secretariat and member of the Transform Nutrition Consortium Advisory Group gives her reflections.
It has been an incredible privilege to be part of the Transform Nutrition Consortium Advisory Group and to have participated in this Symposium in Kathmandu. The work carried out by Transform Nutrition shows that, in order for the research agenda to be cutting edge, opportunities have to be seized upon and worked with through engagement of key stakeholders, such as academia, research, policy makers, implementers and advocates.
The evidence for action in South Asia generated by Transform Nutrition will help to build bridges in the complex and evolving landscape of nutrition. It highlights with lessons from Bangladesh and India how essential it is to integrate nutrition into health systems. But it also demonstrates that the engagement of frontline workers remains challenging. As illustrated by Kavita Chauhan (PHFI), explaining the story behind the data is vital to increase synergies among people and bring delivery at scale. Findings by Shilpa Deshpande (IDS) were helpful to unravel the identity politics among service providers while the presentation by Rasmi Avula (IFPRI) clarified the incentives that are motivating frontline workers in India. If we want to improve the quality of nutrition services and address challenges of low utilization, we need to understand people and get more of this type of evidence.
We know that Governments invest in social protection programmes. But how do we make them work for nutrition? The results from a study in Bangladesh by Akhter Ahmed (IFPRI) confirm that adding intensive Behaviour Change Communication to cash transfer programmes provides the greatest gains for nutrition. Yet, more research is needed on how this can be replicated at scale. The diagnostic by Suman Chakrabarti (IFPRI) on how big drivers of social spending can be analyzed using a nutrition lens could be applied beyond India. If a large-scale programme fulfills its basic mandate, is it feasible to work with implementers and budget holders to incorporate nutrition goals and actions? This type of assessment is timely to explain the politics of financing and ensure that assumptions are studied before important decisions are made.
I had the privilege to chair the session on the Stories of Change together with Zivai Murira (UNICEF) and to hear from the evidence from Nepal, Bangladesh and the Indian State of Odisha. It was an inspiring and motivating session. The Stories of Change led by Stuart Gillespie (IFPRI) have the greatest potential to reach out to communities beyond nutrition. They link together and explain which factors are important in each context. These factors touch upon different sectors, calls for a variety of stakeholders to get engaged and show that multi-disciplinary teams can help to clarify lessons from the past and highlight future scenarios.
It is encouraging to see how the quantitative work by Derek Headey (IFPRI) to analyze the drivers of nutritional change has been applied and customized in the three countries. The presenters – Kendra Cunningham (Nepal), Masum Billah (Bangladesh) and Neha Kohli (India) – demonstrated that the right enabling environment was the required factor in each country but the triggers were specific to each situation. A key take away for me was that a committed and accountable leadership such as the one in Odisha State and Nepal brought together the evidence and the coherence required to enable the change. This would have not been possible, however, without the championship demonstrated by a wide range of stakeholders in moving the nutrition agenda forward.
Transform Nutrition shows that the evidence for action is there and that people can effectively work together to deliver nutrition. This is the time to reach out to all actors with a stake on nutrition. As highlighted throughout the Symposium, a better understanding of the people, be they mothers, caregivers, frontline workers, advocates or leaders, will enable us to act upon every opportunity and bring the change.
When I was growing up in Malawi we tended to link marasmus and kwashiorkor to bewitching – we never linked it to malnutrition. However, I gradually learnt more about food groups at secondary school and University. I started to become more interested in the topic when I was working as Food Security and Nutrition Research Assistant alongside nutritionist in the Area Based Child Survival Development Programme at UNICEF. After a stint as a Government Economist I decided to study the subject and I completed a Masters in Medical Science Human Nutrition in 1997. However, it wasn’t until 17 years later that I would eventually take on a role where I could put this knowledge into practice.
I had been working on diversification of agricultural incomes, marketing and food security issues at the EU Delegation in Malawi for 10 years when in the framework of the 2012 London GlobalHunger Event,the EU made a global commitment to tackling undernutrition. We needed to realign our country programming and because of my background I had an opportunity to take on a lead role. However, after so long without practicing nutrition I really needed to reconnect with the issues and refresh my knowledge so I enrolled in the Transform Nutrition Short Course in 2014.
That one week was very helpful. They approached nutrition from a holistic perspective and presented it as a medical issue as well as a developmental issue. This made me more equipped to engage with stakeholders across the board, instead of looking at it from just one perspective.
The key outcome from the course was a realisation that we needed to carry out a mapping exercise in the nutrition sector in Malawi so that our planning and programming could be informed by what is already happening within the sector. We were able to get all the key development partners and the Government to rally behind this idea and as a result of the mapping, we have now developed a holistic multi-sectoral integrated Four Pillar Approach to addressing nutritional issues that scales up successful previous and existing initiatives and provide a platform for discussion between the different partners.
In July 2015 the Government through the National Nutrition Committee adopted the Four Pillars Approach, and now all partners supporting the government use this framework to coordinate and structure their programs in the countryto ensure the national objectives will be achieved.
The Four Pillar Approach
Pillar 1: Agriculture for food and nutrition security and improved maternal, infant and young child care and feeding
Pillar 2: Health – primary health care, therapeutic care, support and treatment and WATSAN:
Pillar 3: Integration of behavioural change and communication for optimal maternal and young child feeding and care (knowledge, attitudes and practices) among communities, learners, professional and frontline workers through nutrition education
Pillar 4: Governance, human capacity building, research, monitoring & evaluation and fortification.
We have also developed Afikepo, an EU programme to take forward and support the Four Pillar Approach. It translates from the local language as ‘let the children develop to their full potential’ and it has become a moto of some sorts for nutrition programming in Malawi.
Therefore, I took lessons from the 2014 course and applied them in Malawi, which now has the second largest EU nutrition programme in the World. However, I have also enrolled in the 2017 Transform Nutrition Short Course so I can build on my experiences, gain more insights and further improve our programmes and approaches in the country.
Grainne Moloney, Head of Nutrition in Kenya for UNICEF and member of the Transform Nutrition Consortium Advisory Group gave her reflections on the day at the end of our meeting in Nairobi on 8 June 2017.
“Thanks to all for coming today and for your excellent participation. I do feel we are all very privileged to have been able to be here today and have access to such important and cutting edge research that we can immediately take back and apply to our work. Most of the time we are all too busy to reflect on the new papers/ evidence being published so today we had the opportunity to come together in our different communities from Government, academia, research, policy makers, programmers all with a common goal of how to improve the nutritional situation of children in Africa. We had time to openly discuss the latest findings and opportunities of application – this is rare. We also must acknowledge that most regions in the world are now seeing reductions in the absolute numbers of stunted children, with the exception of West Central East and Southern Africa so the learning from today is vital to help us all to get the numbers and indicators moving downwards by applying this learning immediately in our day to day work. The fact that you are all still here after 5pm on a weekday given we are now deep in traffic in Nairobi, also shows your interest in today’s meeting and on behalf of you all I would like to specifically thank the Transform team and the local organizing team of Save the Children for arranging and inviting us all to such an interesting and successful day.
So to provide a quick summary of the 4 sessions: Agenda here
o Session one ~ Stories of Change in Nutrition: Africa set the basis of what works in terms of success stories in stunting reduction based on a review of several case studies- we learned the key common drivers and factors that need to be in place to reduce undernutrition and the case studies illustrated a common theme over and over again. While as a community we have struggled to find the silver bullet to reduce stunting from the quantitative side – now we know the important factors that do have an impact and that it doesn’t have to take generations, that changes in the short term are possible with the right enabling environment – this is something all of us today can carry back to our countries – where we can all write our own story of change and review where we are and what areas we need to focus on more.
o Session two ~ Nutrition sensitive social protection brought the latest evidence on the very topical areas of social protection and nutrition – with 2 solid country examples from Ethiopia and Kenya as well as the review of other studies by John Hoddinott on the potential for its role in stunting reduction. We know the research from Latin America has shown good results – but we have yet to see these same results in Africa – why is that – what are the issues and learning around targeting, monitoring, transfer value and what do we need to consider when we design such programmes. The experience from Ethiopia and Kenya clearly highlighted the evolution of the large Government led programmes for the most vulnerable populations and that over time they are becoming much more nutrition sensitive. It is important to recognize these are dynamic programmes whereby we, as the nutrition community, now need to be more proactive and be at the table to advocate for increased nutrition sensitivity in the design. And let’s generate that evidence for Africa as this is a gap and let’s look at the wider welfare programmes also as an opportunity to influence — and not just cash transfers as ultimately this is the future for support to our vulnerable communities.
o Session three ~ Transform Nutrition research from Kenya and Ethiopia then highlighted several innovative research studies supported by Transform Nutrition that aim to improve nutrition outcomes. The studies ranged from technological innovation in terms of using handheld devices in nutrition programmes which looked not just at the time saving side but also on efficiency and quality assurance to new approaches in using Social Returns on Investment (SROI) and giving a new importance and value to people’s perceptions of caring for their children. Finally we heard 2 case studies that reinforced some of the earlier learning on social protection, that if we don’t make that connection to the household and the behaviors and needs of that household in the design of our programme and only focus on the supply side such as increased production, we will not have an impact on improving nutrition outcomes.
o Session four ~ Leadership in nutrition was a highly inspiring and motivating session where we had the privilege to learn from Transform’s nutrition champions who through their commitment energy and belief in their work- have made extraordinary influence and gains in their sector. Again common themes emerged through each of the stories- and we can all take something from them. The role of leader also was highlighted but not always in the traditional sense of a senior Government official but in all the work we do – we can all be champions to improve the agenda , also the stories highlighted it is not always easy , there are often conflicts of interest that we have to manoeuver but some of the key learning was the importance of getting people together, having a common vision, dealing with the challenges and being self aware of what is possible- so let’s all take inspiration from these great women and do our bit to get nutrition on the agenda in our countries.”
From 2011-2017 Transform Nutrition has been strengthening the content and use of nutrition-relevant evidence, to accelerate the reduction of undernutrition.
On the 8th July 2017 in Kathmandu, Nepal, it will host a regional meeting; ‘Evidence for action in South Asia’ the day before the joint ANH Academy Week and Feed the Future Innovation Lab for Nutrition Agriculture-Nutrition Scientific Symposium, to highlight experiential learning from South Asian countries on key drivers to improve nutrition status.
It will feature evidence on what works in nutrition-sensitive interventions, presented to policymakers from Nepal and international donors and NGOs in the South Asia region. The meeting aims to inform and equip attendees in order to address the particular challenges of tackling child undernutrition in their current contexts. See agenda.
by Neha Raykar, Public Health Foundation of India
Recently, I attended a policy seminar titled ‘Transforming Food and Nutrition Landscape in Assam’ on 29th March 2017 in Guwahati, Assam. The dialogue was co-organized by the Inter-Agency Group, Assam and Coalition for Food & Nutrition Security and was attended by about 50 stakeholders comprising senior policymakers from Government of Assam and Government of India, as well as representatives from local NGOs, educational institutes, and bilateral agencies.
The purpose of the seminar [Read more…]
From 2011-2017 Transform Nutrition has been strengthening the content and use of nutrition-relevant evidence, to accelerate the reduction of undernutrition. On 8 June Transform Nutrition is hosting a regional meeting Using evidence to inspire action in East Africa in Nairobi, Kenya.
This regional meeting will present experiential learning from other African and South Asian countries on key drivers to improve nutrition status, along with evidence on work works in nutrition-sensitive interventions, to policymakers from Kenya and international donors and NGOs in the East Africa region. It aims to inform and equip them to address the particular challenges of tackling child undernutrition in their current contexts. See agenda and press release.
Institute of Development Studies, Brighton, UK
This 5 day course is designed for both policy makers and practitioners. The course will lead participants through cutting edge knowledge and evidence on nutrition globally. Using an interactive diagnostic approach, participants will learn to apply such knowledge to specific national or sub-national situations to identify strategic areas for nutrition action. The course is designed to provide a base from which participants can develop their own future leadership for transformational change in nutrition.
Conference on Delivering for Success at Scale 7- 8 February 2017, BRAC Auditorium, Mohakhali, Dhaka, Bangladesh
This conference built on the longstanding partnership between BRAC, ICDDR,B and the Institute of Development Studies (IDS) to explore the role of knowledge in the conceptualisation, design, delivery and management of development programmes and policies. Bangladesh has been a lead player in the use and integration of research into development decision-making, notably in relation to health systems, nutrition, social protection, agriculture and poverty. Evidence will continue to be important in strategic development planning by the Government of Bangladesh among others.
The conference included examples of how high quality research can be embedded within programmes, showcased research findings, discussed the challenges of integrating research with programmes, highlighted successful examples and discussed future needs. The UK Department for International Development funded Transform Nutrition and Future Health Systems presented relevant research.
Read an article about the conference in the Bangladesh Financial Express ‘On health and nutrition’. We also published a blog by Rittika Brahmachari, IIHMR Pathways to scaling up interventions: reflections from delivering for success at scale
For more information contact Aazia Hossain firstname.lastname@example.org